Grief and Grieving

Topic Overview

What is grief?

Grief is your emotional reaction to
a significant loss. The words sorrow and heartache are often used to describe
feelings of grief.

Anticipatory grief is grief
that strikes in advance of an impending loss. You may feel anticipatory grief
for a loved one who is sick and dying. Anticipatory grief helps us prepare for loss.

What is grieving?

Grieving is the process of
emotional and life adjustment you go through after a loss. Grieving after a
loved one's death is also known as bereavement.

Grieving is a
personal experience. Depending on who you are and the nature of your loss, your
process of grieving will be different from another person's experience. There
is no "normal and expected" period of time for grieving.

What are common symptoms of grief and grieving?

A
wide range of feelings and symptoms are common during grieving. While you are feeling
shock, numbness, sadness, anger, guilt, anxiety, or fear, you may also find
moments of relief, peace, or happiness. And although grieving is not simply sadness,
"the blues," or
depression, you may become depressed or overly anxious
during the grieving process.

The stress of grief and grieving can
take a physical toll on your body. Sleeplessness is common, as is a weakened
immune system over time. If you have a chronic
illness, grieving can make your condition worse.

How is grieving treated?

Social support, good
self-care, and the passage of time are usually the best medicine for grieving.
But if you find that your grief is making it difficult to function for more
than a week or two, contact a grief counselor or bereavement support group for
help.

If you have trouble functioning for longer than a couple of
weeks because of depression or
anxiety, talk to your doctor. Treatment with medicines
or counseling can help speed your recovery.

Cause

Grief and
grieving are the natural response to a major loss, such as the death of a loved one. Loss can cause
feelings of grief, sometimes when you least expect it.

You may find that old feelings of grief from past loss can
be triggered by current experiences or anniversaries of that loss. This is
normal.

Anticipatory grief is grief that happens in advance of an impending loss. You may feel anticipatory grief because a loved
one is sick and dying. Anticipatory grief helps us prepare for loss.

Symptoms

Your experience of
grief is likely to be different from another person's.
Similarly, you will probably grieve somewhat differently each time you
experience a significant loss. Your reaction to loss is influenced by the
relationship you had with the lost person and by your
general coping style, personality, and life experiences. How you express grief
is influenced in part by the cultural, religious, and social rules of your
community.

Intense grief can bring
on unusual experiences. After a death, you may have vivid dreams about your
loved one, develop his or her behaviors or mannerisms, or see or hear your
loved one. If you feel fearful or stressed by any of these experiences, talk to
your doctor and a mental health professional or clergy person
experienced in
grief counseling.

Age and emotional
development influence the way a person grieves a death.

Children younger than age 7 usually perceive death as separation. They may feel abandoned and
scared. And they may fear being alone or leaving people they love. Grieving young
children may not want to sleep alone at night, or they may refuse to go to day
care or school. Children under age 7 usually are not able to verbally express
their feelings. Instead, they tend to act out their feelings through behaviors,
such as refusing to obey adults, having temper tantrums, or role-playing their
lives in pretend play. Children younger than age 2 may refuse to talk. And they may be
generally irritable. Children between the ages of 2 and 5 may develop eating,
sleeping, or toileting and bed-wetting problems.

Children between the ages of 7 and 12 often perceive death as
a threat to their personal safety. They tend to fear that they will die also
and may try to protect themselves from death. While some grieving children want
to stay close to someone they think can protect them, others withdraw. Some
children try to be very brave or behave extremely well. Others behave terribly.
A grieving child may have problems concentrating on schoolwork, following
directions, and doing daily tasks. Children in this age group need to be reassured that they are not responsible for the death they are
grieving.

Teens perceive death much like
adults do. But they may express their feelings in dramatic or unexpected ways.
For example, they may join a religious group that defines death in a way that
calms their feelings. They may try to defy death by participating in dangerous
activities, such as reckless driving, smoking cigarettes, drinking alcohol,
taking illegal drugs, or having unprotected sex. Like adults, preteens and
teens can have suicidal thoughts when grieving.
Warning signs of suicide in children and teens may
include preoccupation with death or suicide or giving away belongings.

What Happens

Grieving a significant loss takes time. Depending on
the circumstances of your loss, grieving can take weeks to years. Grieving helps you gradually adjust to a
new chapter of your life.

Becoming aware of a loss

Full awareness of a major
loss can happen suddenly or over a few days or weeks. While an expected loss
(such as a death after a long illness) can take a short time to absorb, a
sudden or tragic loss can take more time. Similarly, it can take time to grasp
the reality of a loss that doesn't affect your daily routine, such as a death
in a distant city.

During this time, you may feel numb and seem distracted. You
may search or yearn for your lost loved one. Funerals
and other rituals and events during this time may help you accept the reality
of your loss.

Feeling and expressing grief

Your way of feeling
and expressing grief is unique to you and the nature of your loss. You may find
that you feel irritable and restless, are quieter than usual, or need to be
distant from or close to others. Or you may find that you aren't the same person you were
before the loss. Don't be surprised if you experience conflicting feelings
while grieving. For example, it's normal to feel despair about a death or a job
loss yet also feel relief.

The grieving process does not happen
in a step-by-step or orderly fashion. Grieving tends to be unpredictable, with
sad thoughts and feelings coming and going, like a roller-coaster ride. After
the early days of grieving, you may sense a lifting of numbness and sadness and
experience a few days without tears. Then, for no apparent reason, the intense
grief may strike again.

While grieving may make you want to
isolate yourself from others and hold it all in, it's important that you find
some way of expressing your grief. Use whatever mode of expression works for you. Talking, writing, creating art or music, or being physically active are
all ways of expressing grief.

Spirituality often is part of the
grieving process. You may find yourself looking for or questioning the higher
purpose of a loss. While you may gain comfort from your religious or spiritual
beliefs, you might also be moved to doubt your beliefs in the face of traumatic
or senseless loss.

Grieving problems. In
this complex and busy world, it can be hard to fully grieve a loss. It is
possible to have
unresolved grief or
complications associated with grieving, particularly
if you:

Experienced the
unexpected or violent death of a loved one, such as the death of a child or a
death caused by an accident, a homicide, or a suicide.

Have special
life circumstances that act as
obstacles to grieving, such as having to return to
work too soon after a death.

Have a history of
depression or
anxiety.

Adjusting to a loss

It can take years to
go through a grieving process. Feelings of grief may return during holidays, birthdays, and other
special events.

With loss,
your sense of self and security is disrupted. It may help to develop or strengthen connections with other people,
places, or activities. These new parts of your life are not meant to replace
what you have lost. Instead, they serve to support you.

Treatment Overview

Grief itself is
a natural response that doesn't require medical treatment. But sometimes people
need help getting through the grieving process.

Initial grief

Medicine. During the
initial days of grief,
anxiety or sleeplessness can make it difficult to
function. If you suffer more than a few days of severe agitation, talk to your
doctor about whether a short-term prescription
sedative medicine can help you. (Doctors
disagree about the usefulness of medicines for people who are grieving. Some
doctors believe that giving medicines for anxiety or sleep may
interfere with the ability to grieve.)

Counseling. If you find that
obstacles to grieving are making it difficult to
function after a loss, talk to a
grief counselor, attend a bereavement support group,
or both. Counseling and support groups can also help you work through
unresolved grief from a past loss.

Chronic grief and complications

If you or someone
you know exhibits
suicidal behavior (such as thinking you cannot stop yourself from harming
or killing yourself), call 911 or other emergency services immediately.

Home Treatment

Coping with grief

Home treatment plays an
important role in working through the
grieving process. Talking about the loss, sharing
cares and concerns, and getting support from others are very important
components of healthy grieving.

If you are caring for a dying
loved one, it is important to take good care of yourself also. When you know
that a loss is approaching, especially if you are able to participate in the
care of a loved one who is dying, you may be better able to recognize and deal
with your feelings of grief. It is important that you get
caregiver support to help you care for your loved one
as well as to help you prepare for your loss.

If you have just
had a major loss in your life, it is important to:

Get enough rest and sleep. During sleep, your mind makes sense of what is happening in your
life. Not getting enough rest and sleep can lead to physical illness and
exhaustion. Try activities to help you relax, such as
meditation or
guided imagery.

Eat nourishing foods. Resist the urge not to eat or to eat only those foods
that comfort you. If you have trouble eating alone, ask another person to join
you for a snack or meal. If you do not have an appetite, eat frequent small
meals and snacks. Consider taking a multivitamin daily.

Exercise.
If nothing else, take a walk. Brisk walking and other forms of exercise, such
as yoga or
tai chi and qi gong, can help release some of your pent-up emotions.

Comfort yourself. Allow yourself the
opportunity to be comforted by familiar surroundings and personal items that
you value. Special items, such as photos or a loved one's favorite shirt, may
also give you comfort. Treat yourself to something you enjoy, such as a
massage.

Try to stay involved. Staying involved in activities that include your
support network, such as work, church, or community activities, may help you as
you grieve.

To help you work through the grieving process, make sure
to:

Surround yourself with loved ones. You may feel lonely and separate from other people when you are
grieving. You may think that no one else can understand the depth of your
feelings. Surrounding yourself with loved ones and talking about your feelings
and concerns may help you feel more connected with other people and less
lonely.

Get involved. Take part in the
activities that occur as a result of the loss, such as making funeral arrangements.

Avoid quick fixes. Resist the
urge to drink alcohol, smoke cigarettes, or take nonprescription medicines
(such as sleeping aids). When you are under emotional stress, these may only
add to your unpleasant feelings and experiences and may mask your emotions and
prevent you from normal, necessary grieving.

Ask for help. During times of emotional distress it is important to allow
other people to take over some of your responsibilities. Other people often
feel the need to show you how much they care about you.

Helping others cope with grief

There are many ways
that family members and other people close to a person who is grieving can give
help and support. The best way to help a grieving person often depends on how
well the person was prepared for the loss, the person's perception of death,
and his or her personality and coping style. The person's age and stage of
emotional development are also important to think about when you are helping a person who
is grieving.

If someone you know is grieving:

Encourage the person to grieve at his or her
own pace. The grieving process does not happen in a step-by-step or orderly
fashion. There will be good days and bad days. Do not try to "fix" the person's
grief. Provide support and be willing to listen.

Be sensitive to
the effect of your words. But don't ignore the person who is grieving just because you aren't sure what to say. Check in regularly during the first year and beyond, especially on important days, including the anniversary of the death, holidays, and birthdays.

Recognize that this person's life has
changed forever. Encourage the person to participate in activities that involve
and build his or her support network.

Respect the person's personal
beliefs. Listen to his or her feelings without making judgments. Do not try to
change the person's beliefs or feelings.

Helping young children who are
grieving can be challenging for adult caregivers. The best way to help a child
varies according to age and emotional development.

Older adults may not express grief
in the same way as other adults. Older adults are more likely to become
physically ill after a major loss. They may already have a chronic physical
illness or other conditions that interfere with their ability to grieve or that
become worse when they are grieving. Also, older adults may be likely to
develop
complications associated with grieving. Older adults
may be more likely than other people to experience several losses in a short
period of time.

McGolderick M, Walsh F (2011). Death, loss, and the family life cycle. In M McGoldrick et al., eds., The Expanded Family Life Cycle: Individual, Family, and Social Perspectives, 4th ed. Boston: Allyn and Bacon.

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